Sedative Restorations

Sedative restorations are placed for several different reasons. The most common reason is tooth pain. The pain may be constant, intermittent, or a reaction to sweets or a cold or hot stimulus. If the sensitivity is due to decay and it is very deep and close to the nerve, there is the possibility of exposure of the pulp (nerve) once all the decay is removed. If the cavity is especially deep, as much of the decay as possible will be removed, and a medicated, sedative filling will be placed in the tooth. This will serve to calm the nerve and give it a chance to heal. The sedative restoration, if done for this reason, should stay in your mouth for a number of weeks. Then the sedative restoration will be removed and the tooth will be examined to determine the need for further treatment. It may be able to be restored with a filling or cast restoration. However, if the decay was quite deep and the nerve does not heal, endodontic treatment (root canal therapy) will be required to alleviate pain and save the tooth.

If you have multiple large cavities and/or other serious dental problems, we may choose to first restore all the teeth with sedative restorations. This will quickly stabilize all the teeth so that they do not continue to deteriorate from the decay. Then the other, perhaps more serious dental problems, can be addressed and treated. Once you are out of an emergency situation, we will have the time to thoroughly plan the best methods to restore the teeth.

A third use of sedative restoration is an aid in diagnosing sensitive teeth. You may have a problem with a single tooth, or perhaps you are unable to specifically pinpoint the exact tooth. If the tooth (or teeth) already has a restoration in it, we may need to remove the restoration and directly look at the prepared portions of the tooth. If we do not feel that it is appropriate to place a final restoration at that time, we will place a sedative restoration to be in place for a few weeks. Occasionally, the tooth feels better as soon as the sedative restoration is placed. However, it will still be necessary to observe the tooth for a few weeks before placing a final restoration.

Infrequently, the placement of the sedative restoration offers no apparent relief. In this case other possibilities must be explored. Most often the tooth will require endodontic treatment. Other times, it just takes several days to get a positive result. If possible, give the sedative restoration time to work. But under no circumstances must you live in constant pain. Do not be afraid to call and ask to be seen if the sedative restoration does not appear to be effective.

If you have any questions about sedative restorations, please feel free to contact us at any of our three office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Make Eyes at Your Dentist- It's Normal!

Few people come as close to the average face as a dentist does. Ophthalmologists hide behind those steampunk-y binocular machines; makeup artists have long-handled brushes; and dermatologists get to worry about other parts of the body for hours at a time. But dentists and dental hygienists have no way around it: They spend most of their days inside the faces of people who aren’t their sexual or romantic partners. Lying helpless in a reclining chair, the best a patient can do to make the too-intimate experience less awkward is close her eyes until it’s over. Shutting your lids until the rinse-and-spit command is the normal thing to do.

Or is it? Some dentists make active small talk, and it seems rude to zone out or avoid eye contact when you’re meant to grunt in assent or smize at a joke. Dentists who install iPads or TVs overhead seem to invite an open-eyed approach to their open-mouthed examinations. Then again, unprotected eyes may get flecked with water, spit, and whatever particles the dentist’s tools dislodge. How are we supposed to know which way our eyelids should go?

An unscientific anonymous poll of 114 of my friends and acquaintances suggests that nobody knows. “It literally never occurred to me to close my eyes,” one person responded. “It's weird to look into the dentist's eyes! It feels like I'm seeking intimacy, when really I just want my teeth cleaned,” wrote another. There were many strong opinions in the responses, but no clear consensus on right and wrong. When it comes to eyes at the mouth office, it’s “I feel awkward AF looking into my dentist’s face” versus “Closed feels weird, right? I feel like closed is the weird one here.”

I’d never thought to be concerned about my behavior in the dentist’s chair until my last dental cleaning. Halfway through the appointment, I realized that my eyes weren’t just closed—they were clenched shut, with quivering eyelashes and a furrowed brow to boot. I relaxed my face, not wanting my dentist to think I was in pain or stressed out about a simple cleaning. Then, a horrifying thought entered my mind: What if my eyes aren’t supposed to be closed at all? I’ve never seen anyone else get their teeth cleaned—it’s totally possible that everyone else watches the entire procedure, and my dentist thinks I either have an intense phobia of flossing assistance (I don’t) or an intense fetish for latex gloves, closing my eyes to fully savor the experience of her hands in my mouth (not true).

So it gives me great pleasure and relief to report that there seems to be no weird way to get your teeth cleaned. My poll responses show a healthy split: About 56 percent keep their eyes open, 37 percent close them, and 7 percent do a little of both.

But what do the professionals think? Eileen Danaher, a Rhode Island dentist who’s been practicing for three years, says about 60 percent of her patients keep their eyes open for cleanings, though she attributes that majority in part to her talkative chairside manner. Pennsylvania-based dentist Gulia Omene thinks most of her patients keep them open, especially during cleanings—that’s when they’re looking for “feedback on their gum tissue” and are more receptive to chatter, she says—though her assistant thinks it’s closer to 50-50. For more involved procedures, the ratio flips. Danaher estimates that 95 of her patients shut their eyes for an injection in their mouths; about 53 percent of my poll participants said they close their eyes for anything more complex than a simple cleaning.

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Danaher believes her patients decide what to do with their eyes based on their least favorite part of the dental experience: Those most bothered by the sight of sharp instruments or the bright light overhead close their eyes, and those unnerved by the sounds of drills and whirring brushes keep them open to have some sensory distraction. Meditators and deep breathers close their eyes; people who distrust dental professionals—like my survey participant who prefers an open-eyed exam “to make sure no funny business is going down while a stranger's hands are in my mouth”—watch the whole procedure as it happens.

Dental workers have come up with all sorts of visual stimuli to make the time go by for open-eyed patients. I used to visit a dental office with comic strips taped to the ceiling; a colleague’s dentist has decorative panel that look like calm, puffy clouds on the fluorescent overhead lights. Bougier locales have mounted televisions or iPads within view of the chair, and some offer dark glasses to shield a patient’s eyes from flying debris and the exam light. Danaher’s dream is to get a giant “Where’s Waldo?” panel for her ceiling if she ever opens her own practice.

If so many dentists provide so many forms of in-chair entertainment, open eyes must be the norm—right? For some, taking the hint still feels inconsiderate. “I feel [like closing my eyes is] polite to the dentist/technician. If I were in their shoes, I'd be able to focus better if I didn't have a pair of scared eyes in my face,” wrote one poll participant. Another guessed that open eyes would seem “creepy-like” to a dentist at work. The dentists I spoke with roundly dismissed that fear. “It’s never awkward if your eyes are open,” Danaher told me. “You’d think being in that close proximity to somebody, it would be—but we’re two feet away from people all day long, so that doesn’t bother me. Now, if somebody was staring me dead in the eyes and not blinking, that might be a different story.” Danaher’s father, Gerald, a Syracuse-based dentist who’s been in the field for 30 years, says about 70 percent of his patients keep their eyes open, which helps him keep tabs on their experience. “Usually the eyes will tell me how they’re doing,” Gerald told me. “The look in their eye—if they’re darting back and forth, I’ll ask, ‘Are you feeling something?’”

Usually, dental patients in pain or the throes of anxiety will close their eyes. That’s not a problem, dentists say, unless they’re tensing up the rest of their faces, too. Jack Greenspan, a Connecticut dentist (and my partner’s dad) who’s had his hands in people’s mouths for 49 years and counting, says the only strict command he ever gave as a captain and dentist in the Air Force was to a terrified lieutenant who’d scrunched up his eyes and cheeks too tight to accommodate dental instruments. “This is a direct order, lieutenant,” Greenspan said. “Relax your face now.”
But for a lucky few, closed eyes mean the ultimate form of relaxation: a nap. Yes, reader! Some people—some magical, super-Zen, rubber-jawed people—actually conk out while a stranger takes a drill to their molars. Dentists say they love it when their patients fall asleep in the chair. “People will sometimes walk in and say, ‘Oh my God, I’m so nervous,’” Danaher says. “When those people fall asleep, it’s a giant win. It’s the biggest compliment you can give your dentist.” This perception can work in a nervous patient’s favor. One of my survey respondents wrote that, at the dentist’s, “I pretend I am taking a nap since it's weird to be in a room with someone for half an hour and not speak to them.
Faking sleep is extreme; most people who close their eyes at the dentist’s are just relaxing or spiriting their minds away from the physical discomfort and forced intimacy of a dental exam. They are also not normal. Open is the favored eye position of a small majority of dental patients, and dentists seem to be molding their exam rooms, with their fancy TVs and elaborate ceiling decorations, to that norm. Keeping your eyes open will put you in the company of the majority of your peers, so dentists will be ever so slightly less likely to consider you abnormal. Whether normalcy is worth the occasional fleck of plaque to the eyeball is your call.

By: Christina Cauterucci
http://www.slate.com/blogs/normal/2016/10/05/at_the_dentist_should_eyes_be_open_or_closed.html

 

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Extractions

Reasons for Recommending Tooth Extraction
Teeth may need to be extracted for several reasons, including but not limited to:

• severe periodontal disease
• irreversible damage to the nerve tissue inside the tooth (and the patient decides against saving the tooth)
• failed endodontic therapy
• extreme fracture or decay of the tooth structure
• improper positioning of the tooth or for orthodontic purposes

To a great extent, the reason for the extraction will influence the amount of discomfort you might experience subsequent to the procedure. When the tooth is to be extracted for periodontal reasons, there will be reduced bone support for the tooth and the tooth might be removed more easily than if there were full bone support. In this case, there might be lessened discomfort following the extraction.

The Procedure
1. Numb the tooth: Your dentist will need to anesthetize (numb up) both your tooth and the bone and gum tissue that surround it. This is done as an injection.

2. Extraction: The root portion of a tooth is firmly encased in bone (its socket), and tightly held in place by a ligament. During the extraction process, the dentist needs to both "expand the socket" (widen and enlarge it) and separate the tooth from its ligament, to the point where the tooth is loose and free to come out.

• What does it mean to "expand" a tooth's socket? If you have ever tried to remove a tent stake that has been driven deeply into the ground, you know that you can't just pull the stake straight up. Instead, you first have to rock the stake back and forth, widening the hole in which it is lodged. Once the hole has been enlarged enough, the stake will come out easily.
• How does the dentist expand the jaw bone? The bone inside the jaw is spongy. When a dentist applies firm pressure to a tooth (forcing it against the side of its socket), the bone will compress. After repeated application of pressure, from many different angles, the entire socket gradually becomes expanded. At some point, enough space will have been created (and the ligament separated from the tooth enough) that the tooth will come out.

3. Closing the extraction site: Once your tooth has been removed, your dentist will begin the process of closing your extraction site. This may include:

• Removing infected or pathologic tissue by curetting (scraping) the walls of the tooth socket
• Using finger pressure to re-compress the "expanded" socket
• Rounding off sharp bone edges
• Evaluating the tooth socket for sinus complications (upper back teeth)
• Washing out ("irrigating") the socket, so to remove any loose bone or tooth fragments that remain
• Placing stitches (usually only after surgical extractions).
• Placing folded gauze over your extraction site and then having you bite down on it so to create firm pressure

The Tools

1. Dental Elevators: During the extraction process, a dentist will usually use an elevator first. These instruments are designed to be wedged in the ligament space between the tooth and its surrounding bone. As the elevator is forced and twisted, the tooth is pressed and rocked against the bone. This helps to expand the socket. It also helps to separate the tooth from its ligament. As this work is continued, the tooth will become more and more mobile. In some cases, the elevator may be able to shove the tooth on out. If not, the dentist will switch to the use of extraction forceps and remove the tooth with them.

2. Extraction Forceps: A dentist will usually keep a number of different extraction forceps on hand. Each one will have a design that's been specially made to grasp a certain type of tooth. When they're used, the dentist will grasp the tooth with the forceps and them firmly and deliberately rock it back and forth as much as it will. Because the bone that surrounds the tooth is compressible, the socket will expand. In addition to a rocking motion, a dentist will also rotate the tooth back and forth. This twisting action helps to rip and tear the tooth from the ligament that binds it in place. At some point, the socket will be enlarged enough, and the ligament torn enough, that the tooth can be easily removed.

What will I feel?
1. Pressure
2. You should not feel any pain 
3. Expect to hear startling extraction noises: These are often just routine

Following the Extraction
We will tell you the reason for the extraction and let you know what to expect following the procedure. Please follow the instructions given to you. If antibiotics are prescribed, take them until the prescription is completely finished. If pain medication is prescribed, take it only if necessary. If the medication prescribed contains a narcotic component, such as codeine, do not drive a motor vehicle or operate machinery that could prove dangerous to yourself or others. Expect some bleeding to occur from the extraction site for the first 24 hours. Remember, there is now a hole in your jaw from which the tooth has been removed, and the hole can be quite large. Some bleeding is to be expected.

• Do not spit, rinse, or smoke for 24 hours
• Do not drink through a straw for 24 hours
• It would be a good idea not to brush near the extraction site for a day or two
• When you brush and floss the area, be gentle!
• For 24 hours after the extraction, try to chew food away from the extraction site
• Some slight swelling in the area is to be expected, especially if the extraction was difficult
• If sutures are placed, return to have them removed
• If medication has been prescribed for possible post extraction discomfort, take it as directed
• If prescription medication has NOT been given, you may take your usual over-the-counter pain reliever, as directed

 Please notify us if:

• There is extended bleeding from the extraction site. Slight bleeding for several hours is normal.
• Anything other than slight swelling occurs.
• Discomfort continues for more than 24 hours, especially if it is not relieved by over-the-counter pain relievers.

Some infrequent complications of routine oral surgical procedures include (but are not limited to):

• fracture of adjacent teeth or restorations (which of course would mean that these affected areas must be restored to normal function after the healing of the extraction site)
• separated root tips or root fragments
• temporary or permanent nerve damage to the area, resulting in anesthesia or paresthesia (numbness)
• incomplete healing, resulting in severe pain - a "dry socket"
• fracture of the surrounding bone

If you have any questions about reasons for dental extraction, please feel free to ask us.